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tv   Charlie Rose  WHUT  July 8, 2010 11:00pm-12:00am EDT

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>> welcome to our program. tonight because of many viewer requests, we bring you another look at the 9th episode of our brain series, it originally aired on june 22nd. in this episode we look at mental illness. >> in around 1900 revolutionized the field. people had not known they were dealing with a number of different illnesses or one major illness. and he broke it down into two major categories. >> disorders of mood, disorders of thought. and disorders of mood, he characterized depression and manic-depressive illness. disorders of thoughts he characterized schizophrenia which he called dementia precok. dementia early phase of office. we have understandings of
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the nation of these diseases. >> rose: mental illness, the 9th episode of the brain series next. >> it is about the most exciting scientifi scientific-- understanding the brain. its series made possible by a grant from the sigh son-- sigh upon's foundation. to advance grant for research in the basic sciences and mathematics. >> funding for charlie rose was provided by the following:
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>> from our studios in new york, this is a special edition of charlie rose. >> tonight we continue our exploration of the wonders of neuroscience. our subject this evening is mental illness. when our mental processes go awry the results can be devastating. diseases such as depression, by polar disorder and schizophrenia are some the toughest known to humankind. they interfere with a patient's thought, motivation and even one's sense of self. society has stigmatized mental illness for thousands of years. only recently have we come to think of mental disorders as serious medical conditions. this breakthrough in understanding has improved the lives of those stricten and open the door for important research. with proper care, many of the treated are able to lead productive and fulfilling lives. tonight we'll meet two remarkable women who have risen to the top of their field despite suffering from mental illness.
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kay redfield jamison is a world renowned authority on by polar disorder, a disease she struggled with. she a professor at johns hopkins university and codirector at johns hopkins mood disorder center. elyn sachs was diagnosed with skits schizophrenia as a young woman. after keeping the disease private for most of her adult life she publicly revealed her ill innocence 2070. she is a professor at the university of southern california gould school of law and founder of the saks institute the of mental health and policy of ethics. and three scientists who have performed cutting edge research into the biology of mental illness. jeffrey lieberman, he studied the newer joe biology of schizophrenia and related scottic disorders a a professor at columbia university and director of the new york state psychiatric sdut. stephen warren, his research helped isolate the gene responsible for fragile x syndrome. he is now studying the genetic basis of the major psychiatric disorders.
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helen mayberg, her research uses scanning technology to isolate the brain regions involved in clinical depression. she has performed studies that illustrate the positive affects of deep brain stimulation on depressed patients. and once again my cohost is dr. eric kandel, as you know, he is a nobel laureate, a professor at columbia university and a howard hughs medical investigator. so i am pleased to sort of begin this conversation with this sense that for rea'ons you will tell us, this is a dif&ert episode of our series. >> here we are speaking about major psychiatric disorders. as you outline we're going to discuss depression, manic-depressive disorder also call kd bipolar disorder and schizophrenia. and we are going try to understand what is the biological nature of these disorders and what can we do about them.
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these are as you indicated devastating disorders. they affect the way people think, the way-- they affect the way people feel. they affect their motivation. moreover one of the tragic aspects of these disorders is that they affect people early in their lives, just as they are beginning to reach the peak of their productivity, their peak of ability to enjoy themselves. schizophrenia typically begins in college or in the early 20s. although there are vicissitudes in these diseases, of(en they rain with people for the rest of with people for the rest of therefore they are an trelhey rden @for@ the paent and@or society large. fortunately as you've indicated,hese seases e treatable@. and now have some clues@ as to what oimizes treatment. early@ intervention and combination of psycho therapy and drug therapies. >> rose: once again you have a book here which is important because we
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constantly look ahead but at the same time we see the foundations for the kind of studies we made. >> are you absolutely right this is an extremely important guide. the whole history of psychiatry which say culmination is interesting. we have known about these illnesses since the great greek physician not only spoke about depression and manic-depressive psychosis but indicated that these are medical illnesses. but this basic idea was lost on european medicine for the longest period of time. during the middle ages, even later in the renaissance period these were thought of demonic disorders. people possessed by the devil or moral deagain resis and people with mental disorders were put away in insane asylums usual leigh far removed from the center of town and often they were kept in chains so they don't move around. fortunately, this situation
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was reversed in about 1800. the paris school of medicine began to really express a very modern view of medical science. and felipe pinel, a great french psychiatrist realized that psychiatric disorders, as hypocrates has said are medical illnesses and he began to institute humane treatment with beginning with psychotherapy. but between 1800 and 1900, no progress was made in understanding psychiatric disorders. one couldn't localize them specifically so one didn't know if they are one mental illness or they are many. and that's when our mutual hero emol crepl%n came on the scene. in his √°extbks in@ 1902 and untiled-- continueuntil he died in 1926, he outlines for example in his first three chapters, he defines the fact that mental illnesses are not unitary.
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they affect two different processes. these affect mood, emotion on the one hand and they affect thinking on the other. and he defined the disorders that affect mood, depression and manic-depressive disorder. and defined the disorders of thinking as schizophrenia. he called it dementia precox. he thought it was deterioration of the cognitive-- in the brain early in life. and we have insight into the nature of these diseases. we know that depression is an illness that involves mood which is associated with the feeling of worthlessness and inability to enjoy life and antidonia. it is all pervasive, nothing gives one plesh our and a feeling of helplessness, of worthlessness, often leading to thoughts of suicide and tragically to suicide attempts themselves. 25% of people that have depression also have manic-depressive illness. they have the opposite end
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of the spectrum. they feel fantastic at the beginning of the disease, better than they ever felt in their life but ultimately it leads to grandiosity and grand psychotic episode, 9. skets friendia has three types it of symptoms. positive, negative and cognitive. the positive symptoms are characteristic of skits friend ya, the thought disorder, the hallucination, the delusion, the acting crazy. the negative symptoms are the social withdrawal, lack of motivation and the cognitive disorders are the difficulty with organizing one's life, and the difficulty with a certain kind of memory called working memory, short-term memory. fortunately, as you indicated, we now see people who have had effective treatments who have very productive lives. and que jamison and elyn sacks despite the fact that they suffer from this disorder much of their life has rich personal lives,bo
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both of them involved in meaningful interpersonal relationship, marriage that is very satisfying to them. and having secretary pack-- spectacular ago dem -- academic caer roose so there is tremendous hope. >> rose: this is the remarkable thing. before we have had some of the leading and cutting edge scieists involved in neurology and brain science. here we have not only two who are engaged in important research and are leaders in their field, but also suffering, living with. >> this gives such hope to all of us that you can have these devastating diseases and with appropriate therapy, you can lead a meaningful, rich life also we will lz find out a bit about the genetics of all of this in terms of genetic basis. are they related biologically? >> well h that is still an active discussion. we're going to hear from steve warren. we're going to hear from jeff lieberman and helen
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mayberg, the biological underpinnings of these diseases. and we know that there are some genes that are different. but it's beginning to emerge that some genes are shared by the two diseases. >> rose: all rig. this is one of the most interesting things we have done. because in addition to the cutting edge science there's also this extraordinary personal testimony. we begin now with our conversation at the table. tell us about depression and bipolar disorder. >> well, i think one of the things that's really interesting about depression and bipolar disorder is that they really affect not only mood but they affect energy and sleep as welling and thinking. so that people request, when they are depressed be very human native, be very obsessive, think often of dying. but the mood is not one some of of sadness as it is really of terrible hopelessness and deadness and disinterest in life. and so all the things that ordinarily are interestinging in life to
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people become irrelevant, basically. and people have trouble sleeping. they have trouble getting to sleep. they have trouble staying asleep. so it's an enormously all inclusive illness. people tend to think of depression just as mood but it's really much, much more than that. and bipolar illness is as eric said is the mania is really in many ways the opposite. people very often have enormously high foods,-- moos, feel better than they ever felt in their life so it is difficult to convince people that are manic that they are sick because they feel great. so it you are talking to an 18-year-old who is saying staying up all night, full of energy, great ideas, or seemingly great ideas, thinking fast and furious, you know, not very convincing to tell them they are sick. that is one of the major clinical problems in treating these illnesss is they do affect people when they are young. and when they are very unlikely to stay in treatment. >> people often speak about psychic pain with depression,
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do you want to speak about that. >> one of the things that is hard toast explain to anyone who has not been depressed is how isolating it is. how painful it is. and that kind of pain, i'm convinced, cannot be put into words. no matter how many many great writers have tried to put it into worxd you simply cannot convey to anyone. when you think about illnesses like terminal cancer where you think people would be thinking of dying and committing suicide, the suicide rate is really quite low. the people who really tend to kill themselves are people when they are depressed. it is a level of agony of arterial agony that is just astonishing. and as i say, isolation, a sense of what's the point, you know. you don't feel human. you can't think it you can't feel. can't love. >> rose: can't some people reach out for suicide. >> absolutely. >> rose: when did you know? >> well, i certainly knew, i first sort of flew quite high as it were when i was about 17. and senior in high school.
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and i felt great. i felt no pain. hi a wonderful time. but it wasn't that different from my usual joie de vivre. so i was noticing that my friends were dropping like flys from exhaustion it didn't seem that bad. what then happened was a crashed completely and i had never been depressed a day in lie life. i never thought about suicide a day in my life or a minute in my life. and all of a sudden i was incapable of remembering anything. concentrating, reading anything at school, making sense of anything. and i just wanted to die. and i went around trying to figure out how i could die. i thought of death. i felt, and i knew something was very seriously wrong. but at that time, i didn't put it into-- nobody talked about depression. nobody talked about bipolar illness or manic-depressive illness. the words weren't there so i didn't know what to do so i did nothing. >> rose: until -- >> well, i kept on that way up and down and up and down for another ten years.
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and then i went flamingly psychotic. i was hallucinating and delusional, manic. spending a lot of money that i didn't have and not wisely and it was a medical emergency. so i was brought, you know, to care as it were. and i was very fortunate i had a terrific psychiatrist who diagnosed what i had absolutely correctly immediately. and i responded very well to lithium. >> rose: but so the interesting thing here is you are, in your field, one of those suffering. >> yes, yes. there is nothing more motivating in life than nearly dying from an illness, which i did because i tried-- . >> rose: that you knew a lot about. >> because you want to know more. you really, are you a little impatient with the pace of the field. and it's very motivating. >> rose: alyn, what do we know about the biology? >> well, our approach of the
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biology of these major mental illnesses came from chemistry. and chemistry has dominated biological research for over 50 years. the major hypothesis with major depression was the biogenic-- hypothesis, sort of a court low on serotonin or epinephrine. and that really was driven by observations of drugs that would alter those brain neuro transmitters. and then the recognition that replacing those neurotransmitters, upping the level seemed to alleviate the symptoms. that really created the foundation for a hypothesis that these were deficits in these brain neurotransmitters. the problem was, is just filling it up the tank didn't keep you well. and that it really didn't accommodate the course of illness for many people. but it did drive a lot of very, very good neuro biology to understand the important role of serotonin in mood regulation, how it
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strengthens. >> and it was their futureically helpful for many people. >> that is the critical point. despite the fact that it doesn't explain all the biology it has changed the lives of so many patients. and as a neurologist we're interested in not just what chemicals but where the chemicals act. and like every other neurological disease, where in this one, in the case of depression you have a mood problem, combined with slowness of movement, motor changes, a change in cognition, people are slow thinking, as well as disorganized but not like we're going to hear about psychosis as well as a disregulation of circadian systems it, your sleep is off, your libido is off, your appetite is off. these are behaviors that we know a lot about where in the brain they live. and with the advent of neuro-imaging it was possible to test the hypothesis, not some of which chemical but what brain regions are doing what. and with tools like positron
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emission or pet scanning or fmri, we can literally map the brain in action and know exactly our brain areas that we ascribe these behaviors to. are they overactive, underactive and we could start to map precisely how the brain circuits-- this disease were. >> helen was very interesting because she came into the field of psychiatrist being a neurologist. and so she was interested in the signeds of things you have been talking about. where is it located. and she was the first person to find a biological marker. an area in the brain that was abnormalally active in depressed patients. dow want to discuss that? >> well, again, we as well as many other investigators using imaging, we're really trying to take groups of people who had classical symptom, not on medicine, and literally see what was wrong with their brains. are areas overactive, underactive, one area or another area. and our work started to
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focus not just on one area but one area became critical, the sub colosal sing youlae. and what we found is its active is overactive in people when they are depressed and at the same time there is actually an affect on the frontal lobe, the thinking parts of the brain that are underactive. so there is almost a tug-of-war as the patients strike where their psychic pain, a very active state of suffering that we think is really driven by this subcolossal. >> is a fantastic advance because it is the first time someone had a good buy logical marker and jeff will show us things like this in schizophrenia as well. this is the first someone had an an tomorrow cac-- anatomical defect and we will learn how you use it. >> rose: fell me about skits friend ya, the clinical syndrome. >> as eric says it is an illness that involves positive some tomorrows like illusions, negative symptoms like apathy and withdrawal
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and cognitive impairment. when i try to explain what a psychotic episode is like, unlike mania which is fun, ahors enormous pain it is like a waking nightmare with all the bizarre images and impossible things happening and the utter, utter terror. only with a nightmare you kind of sit up in bed and you wake up and you can't just open your eyes and make psychosis go away. so that is what it feels like. for myself, i will have prominent, bizarre delusions like i have killed hundreds of thousands of people with my thoughts. i have occasional hallucinations, a big spider walking up a wall, santa claus coming out of a tv, who knows what that was about. and i also have disorganized thinking. so i had a breakdown on the roof of the law school my first semester there and i said to my classmates, you know, are your legal cases being infiltrated with. we have to case the joint. i don't believe in joints but they do hold your body together so lossly-- loosely associated words that when put together don't really make sense.
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and that happens to me as well. i have been very fortunate that except for the first two years of my illness i have not had negative symptoms. >> now are there phases of this? >> you know there are different course indicators, some people might have one episode and be fine. some people are cronically psychotic. some people have episodes with interepisodes being okay which is where i fit in. and on my own kind of course of my ill, i kind of divide it into different phases and in the first phase the kind of pro-- phase where ings this started going wrong i had my first kind of floor i had psychotic episode. i started walking home from school in the middle of the day and felt like the houses were communicating with me, sending messages. are you special, you are especially bad. look, see, you must find it was very scary. when i got oxford i kind of officially broke down. and that is the second period. it started out looking like depression was mild paranoid features but over time develop mood a thought disorder than a mood disorder and i was hospitalized the first year
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for a month, the second year for four months. by the second hospitalization i was having really frank psychotic thoughts like being in the sky were putting thoughts in my head commanding me to do things like walk under in the hospitals tunnels underneath the hospital and hurt myself and things like that eventually they sent me to a psycho analyst which i think was-- idea that would help me because it has been enormously helpful. and during that phase i was not on medication. two things happened. my psychotic symptoms got worse, the positive symptoms got worse so i was like living in the land of psychosis maybe 80% of the time. >> during the analysis it got worse. >> yeah. but the negative symptoms got better. i started being able to relate to people again and work again. and my own theory is through the mechanism of getting connected with the therapist i started getting connected with other people too. then hi a big breakdown in new haven, got into an analysis with another analyst and got on medication and had a big ten-year struggle with whether i needed medication. for me, my motto is the less
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medicine, the less effective and the way i could prove i wasn't really ill was by getting off medication. so i undertook each effort with great gusto and failed miserably. eventually i went to los angeles, i got a great teaching job and my analyst started saying, you know, you should just stay on the medication an get on with your life. and eventually i tried that and this is the fourth phase. got in a great medication, my symptoms hasn't gone away completely. my husband say it like an off on switch, but like a dimmer so at the far end i will have a transient thought like i killed people which i immediately dismissed. further along i will spend 2 or 3 days in the land of psychosis and at the far end i would be crouching in a corner shaking for two weeks, that hasn't happened in a decade. you wrote a book the centerical hold. >> it was hard to come forward and be public. >> hi a lot of people who recommend i not do it including geriatric
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psychiatrist and emeritus professor at ucl say doing it under a pseudonim. i thought that would send the wrong message that this was so offful that you can't say it out loud. >> the two of are you so articulate about your illness which makes the whole thing so understandable to people but you raise an issue that i would like both of you toed ares. you made the point that you couldn't stand being on lithium, that your they werist told you the dose of lithium. she said if you like lithium so much why don't you take some of it. >> this is not too long ago. he suggested i might up my lithium a little bit and i said well if you want it so much, why don't you take it he said you know, kay, i have been treating you for decades. you haven't changed a bit. i think it is a struggle. not a struggle for me any more because i nearly died and i don't struggle but i mean at the beginning i think for most people, the
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idea of admitting yourself. >> plus there is bad side effects. you know, the side effects are very impairing in your work n your personal life. >> but i actually think what you pointed, the narcissistic injury of having an illness and needing medication is really hard to come to terms with. what i say is i used to say i don't want to use a crutch. now i say if my leg were broken of course i would use a crutch. shouldn't i treat my neuro transmitters at least as kindly. i change in how i think about it. >> rose: what about the genetic underlying of this and heredity. >> so we know genetics plays a roam by looking at family histories. so something like schizophrenia occurs about 1% in the normal population but if you have a sibling with schizophrenia then your risk goes up to about 9%. even more striking is if you look at identical twins they share a 1% of their genome and the risk is nearly 1-- 50% it is not 100% with
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simple genetic trait like cystic fibrosis where both would have the same disorder. here half are discordant or do share that disease. that says then that there are other factors playing a role like environmental factors. you thee that also looking at nonidentical twins who are essentially just siblings but yet they have a higher risk than normal siblings because they share more of an environment. so we think of complex disease as now having contributions of the genome as well as contributions of the environment. usually it's easier finding the genetic factors first and then trying to sort out the environment rrz even though there are a lot of genes involved here. >> that is the problem. we know that it's not one gene. we don't know quite how many genes but it's probably a handful of genes but what we
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are learning in the last several years is the brain unlike many other organs presents an enormous mutational target there have so many proteins that contribute to how the brain works that if you disrupt any one of them you might have a similar outcome. and so the different genes might all lead to the same types so it gets to be kind of a hard thing to narrow down. but it is complicated but i think now with the new technologies that have he morning-- emerged in a couple of years, the sequence genomes rather cheaply in other technologys it at least gives us optimism that we'll be able to identify these genes in the future. >> charlie, elyn gave a beautiful description of the mental state of schizophrenia and steve has just told us that genes contribute to the risk to develop it. so what it means is that the seeds for the illness schizophrenia are really sown during early
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development in gestation, the fetus and the developing brain. and it affects the way not all cells in the brain but a select group of neuro circuit, the same kind of circuits that exist in computer chips or in stereo equipment, come together and function. now genes confer a certain degree of risk which environment can either increase or can maybe reduce. so famine or nutritional deficits during exposing the fetus during pregnancy may have this affect. exposure of the fetus to infection during like influenza epidemics or toxic exposure if the mother does drugs or happens to have some type of toxic exposure can amplify this risk. but then during childhood this vulnerability is pretty much dormant. and individuals vul neverable to schizophrenia, these neuro circuits during adolescent, during young adulthood can begin to
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become dysfunctional. it occurs often times in the context of stress. like when elyn was in school taking final exams, going to college, experiencing recreational drugs, maybe being drafted and going into the military. these stresses cause a dysfunction of these neurocircuits which result in the disregulation of the chemicals that helen was referring to. but in this case, involving dopamine. and this stimulation becomes excessive and leads to the psychotic episodes that helen was experiencing. the hallucinations and dilutions in the brain. the neuro circuits involving dopamine really have three different pathways. one projects from the brain stem into the temp oral lobe and this leads to the sigh could seis, the psychotic. the other leads from the brain stem into the frontal core text and this affect its cognitive functioning.
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and a third projects the the striatum and interest in things. so these three different pathways when the dep amin becomes disregulated under stress during the early late adolescent, early adulthood in life lead to different clinical manifestations which come together to form the illness that creplin diagnosed. now right then treatment can stabilize the illness but all too often people don't come to treatment until after it's-- they've been sick for many years. and or they stop their medicine and get sick again and when this happens, and you have repeated insults to the brain and disregulated functioning, these neuro circuits secreting dopamine, this leads to a progression. and the progression like somebody who has multiple little strokes can lead to some decline in which people are not able to recover to the same level. and if you actually take brain scans over time, you can see the subtle but
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perceptible loss of brain grey matter which is reflecting the elimination of the synaptic connections. >> rose: tell me b kay, because you have earns ed this, grief and depression. >> i got very interested in grief and depression just because i had both. i certainly had a lot of personal familiarity with depression and clinical. but my husband died about five or six-- seven or eight years ago. and i was-- struck then by the differences between grief and depression. even though they often get put together in the same category. grief is something that all of us will experience, have already experienced, will experience. and depression is something that a lot of people will but not everyone. and the question is what, why do they exist and how are they different. and so i struggled with that in a book to try and sort those things out.
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and one of the things that is most striking about grief is that when you grieve, you feel alive. even though you may be desperately sad and unhappy and missing and mourning, you feel alive. you don't feel unconnected with the world. and in fact, you can rather easily reconnect with the world if friends come in or you go out on engagements. and in fact, grief comes and goes in very much waves that when you least expect it. but it's not an unremitting state. and you don't die inside. whereas with depression, depression is a deadened state that's unremitting that doesn't respond to the world around you, to the environment. you could be told the best thing in the world, the worst thing in the world and it doesn't have that much of an impact. it's an internal state. and one of the concerns that i have along with a lot of my colleagues, of course s that you don't want to medicalize the human condition. you don't want to start putting people in psychotherapy or giving them
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medications because they are grieving. i mean it's human-- it's the human condition and it's part of what we learn. you move on from, you learn about. >> rose: so the chall seng to make sure you distinguish the two. >> that's right. >> yes, and that you recognize when people have actually the real challenge is to recognize when people have both. so that you can treat the depression without people having to go through additional horrendous pain. you can treat that which is treatable. and then leave to nature that which is nature. >> he is wrote a marvelous book called "nothing was the same" when-- first of all richard watt her husband was a fantastic guy, major psychiatrist and the two of them had a great influence on each other's lives which she described very beautiful it was actually sort of a love story, the book. and she just expressed it so beautifully the difference between this grief that, you know, comes and goes. it's not all the time. you can be moments of joy that you can experience that
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you can't when you have the depression. >> it's quite interesting because you can actually study intense personal sadness and map it and get a signature of that. and you can actually do that same thing in people who are depressed and actually look at the difference between being depression-- depressed and being depressed and situationally sad. and there are areas of the brain that are different and what just struck me t kind of was a light bulb moment for me right now from some our own data that the part that differs is an area of the frontal cortex that is responsible for 9 invest connectedness. and in depressed people when they are currently depressed and get sad that area of the brain doesn't come on as it does in healthy people who are personsing-- experiencing a past episode, recollecting a sad event. >> if you look at how society responds to you if you are depressed, as opposed to when are you griefing, everyone can reach out to you or almost everyone unless they are complete creeps, i mean, but
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for the most part people really will reach out to you if they know you have undergone a loss like a death. and they will do so. and those rituals will work for a while. not totally but they will work. and society has evolved ways through religion and friendship to do that. in depression, people avoid you because it is first of all depression is contagious. the mood is contagious. and secondly they have a rel sense that they can't connect. they cannot make a connection with you. you cannot make a connection with them. >> one of the interesting things that emerges with both of you is that you have treatment fairly early in your disease, that was a very interesting combination of treatments. and very effect any both of your cases. i wonder whether you could say something about that. >> well, we have talked about this a lot. i am a huge admirer of everything she has done and her writing. and one of the things we talked about is it's not just medication.
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i'm completely beholden to medication. i would be dead as a dead duck without it. i don't have any question about and a half. and i believe in it skan difficultically, personally, whatever. but psychotherapy has been lifesaving. and we both have been fortunate and certainly i speak for myself to have tremendously good psychiatrist who did not make the distinction between psycho pharmacology and putting it over here and psycho therapy over here. he did both. and he did it both with easy and grace and tremendous skill. knew an he more nous-- enormous amount about the illness and enormous about the human condition and human nature and it is just tremendously important. >> what is so beautiful about this is one tends to think of psychotherapy and drugs as working in very different ways. one is talk therapy and the other is biological. and now it's clear that from helen studies that other people studies that psycho therapy works on the brain. at he a a biological
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treatment. >> so the psycho therapy produces a biological change in the brain. >> it's like a biological treatment. when you and i are having a conversation it changes our brain. it is a biological interaction. >> like i say, the important thing to keep in mind is when are you talking about mood disorder, bipolar disorder, depression and schizophrenia we are talking about a pathologic condition that medication helps to restore the neuro-chemical balance but that in addition the value of psycho therapy and i'm going to say something that is a little bit provocative, but it's the therapy but it's fundamentally the consistent, the supportive and the healthy relationship that the individual giving the psycho therapy provides. >> absolutely. these are the key ingredients to basically turning around mental illness. making people be able to achieve what kay and elyn have as opposed to leading a life of despair and ability
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to be productive. >> i was given a grave prognosis. i was expected unable to live independently let alone to work. and i think if i just had medication that would have happened. if i just had psycho therapy that would have happened but together they worked really well. a lot of people think that psycho dynamic therapy isn't optimal for people with schizophrenia but it really helps some, including me. >> we have appreciated for some time, certainly in jeff's department that psychotherapy and drugs go together. elyn's case is very unusual, in the sense there are very few people with schizophrenia who avail themselves of psychoanalysis. so this is really very rare. and you actually describe nicely in your book and some of your talks that insight actually helped you. >> there are a bunch of things helped it if i might run through them. so i think first of all stress is bad for all onuss in particular mental illness and psychotherapy helps you identify and cope with or avoid stressors. second it helps you develop more psychological mindedness and stronger observer ego so
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you can take a step back and observe what is going on in your mind. and third i think is really important t comes to terms with the blow to yourself esteem of having a mental illance and accept it. it is a place to bring your kai otic, scary and drublingive thoughts and say them outloud. >> that is what therapy is about. >> and know are you not alone. >> that's right. >> the reality also is that our current reimbursement systems, how we pay for mental health care, does not support what are you hearing is optimum treatment. >> we have been fortunate in being able to pay. >> they had the resources to do this. >> and it is the standard of care by anybody's study of the study. i mean the psycho therapy and medication is better than either one alone. but the reimbursement system is such-- . >> rose: the reimbursement, are we talking about insurance companies are not recognizing. >> insurance, medicaid and medicare. >> absolutely not. >> medicare too. >> does not. >> kay and elyn had the resources and the families and the intelligence to know
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how to seek the best treatment. but standard payment for health care is not out of pocket, does not pay for these services. >> despite the fact-- . >> rose: what is the rational what do they say the reason? >> it's costly. >> cost containment. >> although it is short sighted in the sense that the one of the other major reasons for psychotherapy is effectiveness s that it doesn't do you any good to have effective medications if people don't take them. and the major clinical problem in treating bipolar ill sense not that we don't have medication, it's that people won't take them. >> schizophrenia as well. >> people don't like to be on drugs for mental illness. >> for a lot of reasons good and bad. psychotherapy helps with that. >> it helps. >> it helps keep you on your drugs. >> yes. >> the physician makes sure that you take it but i think there is another part. there is, this is not an area i'm expert in jeff so correct me if i'm wrong. there is a bias toward mental illness that still persists to a certain degree. and this is really reflected in the reimbursement.
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>> things have gotten bet we are the parody bill. usc which is covered by federal law because we are self-insuranced is very generous with mental health care and i'm getting kite a bit of my psychotherapy paid for so its it's better for many people. >> it is important to recognize that social policys are really self-defeating because although health care expenditures are a huge concern to the economy, we don't support the services that we know will reduce the morbidity of illness across society. >> it an enormous financial burden, mental illness. one of the reasons this is such an historic occasion to see people with serious illnesss who when appropriately treateded have a fan-- fantastic life and contribute importantly to society. >> we couldn't have done it without -- >> this not the typical face of people that you think of for mental illness. you think of the psychotic killer or deranged individual. not productive individuals who have successful careerss. >> rose: under what circumstances do psychotherapy and medication fail? >> the fact that it's very
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clear that despite the fact that there are many, many medications, that can work on individuals and a number of evidence psycho therapy, some people don't get bet we are any combination of anything that we've got. the good news is that the best treatment for depression that we've had, that we've had for a very long time is electric convulsive therapy hand that can get people out of an episode of depression where they may be suicidal and moribund. on the other hand, the more medications you fail, the less likely that ect will keep you well and it has side effects is so we are in a situation that we have people that are suffering in the way we have heard describe that there is nothing that we can do. and they are, it is a malignant situation. >> but you went beyond this. >> we took a different tact. we said look, we're identifying a circuit in the brain that seems to go wrong with people when they are depressed. we see that we can correct the circuit function with medication. we can correct the circuit
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function with cognitive therapy. we can even see its correction with placebo when people recover. and we started to isolate that certain changes needs to happen or you didn't get well. and what we did is we were in the right place at the right time. the work by the neurologists and neurocertains-- surgeons on parkinson's disease recognize that when people stop respond together medications for parkinson's disease that i by knowing the circuits they could target in the circuit directly with focused brain stimulation called deep brain stimulation where an electrode is platesed precisely in the brain by a skilled neurosurgeon and that you could literally tune the abnormalal circuit exactly where you knew it was dysfunctional. so we had a hypothesis that we knew the circuits were depression and that we would go directly at the subcolossal sing you let and say that we want this area to turn down and everything that talks to this brain region to be effected.
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and we literally implanted. and in people who basically everyone had given up on, we targeted that area, turned the electricity on. and saw some incredible things in the operating room. but more importantly, turned down this region, area 25, the subcolossal circumstances singulet and had people recover. >> rose: it is an immediate clearing of the mind. >> immediate. >> to make this point, recovery from depression takes time this is very important to take away from this. but in the operating room t is like we were watching the depression -- >> wake up. >> wake up. it was not that they had an immediate anti-depressant affect. but the psychic pain, they felt differently, that something about the illness had been fundamentally changed by that acute stimulation. but it required continuous stimulation over time to actually maintain the affect. because if you turn it off
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over several weeks, with stress, you will go back to the state are you were in. but it tested the idea that you could tune the circuit directly with electricity. >> rose: does it work in schizophrenia, does it have possibilitys in schizophrenia. >> it absolutely has possibilities. i mean psychiatrist utilizes three modalitys of treatment. talk therapies, medication and brain stimulation therapies. the most common form of brain stimulation historically was shock therapy, which suffers from a bad reputation which is undeserved because it is highly effective when safely administered. >> helen has pioneered the technique developed for parkinson's disease where you have a single lesion, a specific anatomic notion to say this is where the pathology is. and you have then attack it with electrodes. in schizophrenia we have three different circuits that are dysfunctional. so we have to de side exactly where the electrodes should go. and we are not quite there
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yet. >> the work that you have done and our understanding makes one thing that you don't have loss of synapses and nerve cells because there are periods where people can function well. with schizophrenia if the disease persists for some time there is very good evidence from jeff's work and other people's work you lose synaptic connection, what is critical in schizophrenia is what elyn benefitted from. early intervention, the earlier you can diagnosis and one thing that happens is that people who have the disease, the patients like to deceive themselves as both of you did. and the families like to deceive themselves so what one needs to do is remove the stig matic-- stig matta. if you had chest your parents would not say let's wait a few days, they would take you immediately. >> it just a phase. >> what do you think about this. >> i think what he just said is important from the genetic crick, what we would like to do somebody able to
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identify the genes that would predispose an individual to these disorders prior to onset so then they can be perhaps more responsive to therapeutics and prevent the onset ofing-- . >> rose: how are we doing on that. >> we are coming along. the idea is to identify a few genes that plays a big role and that gives us a toehold into the biochemistry of what is going on in the brain it is just like helen said. there is a lot of it circuits and pathways where the genes are contributing. so the highway with every gene is the stoplight or the stop sign. and each individual gene can be changed but it has the 15i78 effect on how the traffic flows. and that's part of the difficulty in identifying these genes is it is so complex. if you just look at the synapse alone there are hundreds of proteins that interact. >> so on everything we are talking about here in terms of depression and disorder and schizophrenia, we are
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all talking about treatment so far. >> uh-huh. >> where is the cure. >> the cure is really not immediately on the horizon but the illnesses if they are identified promptsly and treated effectively can be stopped in their tracks. so we're talking about remission which is within our grasp if we simply get our act in order. in terms of cure, cure will deprebd-- depend on the identification of the genes and the ability to preempt the illness prior. >> rose: for prevention. >> absolutely. but there is an important thing, charlesie to realize, and that is many illnesses are like this. there is no cure for diabetes. it is a lifelong illness. >> hypertension. >> there is no cure for hypertension there are dozens of diseases that you can name. in fact, most of the common diseases, it's a question of good therapy and then maintaining that therapy with watchful waiting. and we see two spectacularly
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rich lives here, of people who still suffer from the disease but it's under very good control. so i think what has to come to grips with the fact that for a long time we will not be able to have cures but that doesn't mean one doesn't have essentially the effective cure that as people living with the disease, struggling periodically but most of the time being able to lead a rich life. >> i want to make one point also that i think with kay and me it's not just that we are successful optionally that we have rich friendships. i have a husband who is amazing. you have a fiancee who is amazing. >> one final part worth emphasizing in this discussion is these are terribly complicated illnesses. this is much more complicated than hypertension or diabetes. these are probably the most complicated illness in all of medicine. >> rose: because? >> because it involves the brain and not just the brain the way it is involved if in prark inson's disease, it involves the highest, most complex functions of the
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brain. >> rose: what is the question you most want the answer to? >> personally i want the answer to how it is that depression is mediated in the brain. what really is the source of the abnormality. we know that gene, environment, chemistry, circuits but we're not really getting at the fundamental source of what makes negative mood progress into a state of absolute other suffering where you can't hold only to anyone else to pull you out of the pit. that is the driving force for me. >> you have heard me ask this before. >> well, the same answer too, probably. go from a gene to behaveier, and understand all the steps in between is just, would be fantastic. particularly something as complex as a psychiatric disease. >> rose: how far away are we from thatness. >> a long way. >> the question that i would prioritize is not so much a scientific one but a social
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one. how can we eliminate stigma. i think the greatest barrier to making gains at a research level as well as a treatment level is making of society accept mental illness as genuine illnesses that require equal treatment to other medical illnesses. >> i have always been interested in the overlap and distinctions between normal mood states and cognitive states, intellectual states, temperment and pathology. because in mood disorder these are very interesting similarities and dissimilarities between-- in terms what is the difference between somebody who is very high voltage, enthusiastic, exuberant, high fire, high energy person and someone who goes on to get just the next step over in terms of not manic but a little-- but enough that it's getting disconcerting and out of control. and why do these things exist. and what is it about human
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temperment that is so adaptive about having so many wide varieties of mperment that a certain number of them that fail or get problematic, i guess trying to keep these conditions within the human condition in some sense of trying to understand them. >> the easy answer is i would like to find the cause and cure of skits friend qa but it is a long-term project and more doable things are studying which psycho-social interventions are helpful for which people with schizophrenia. and bipolar illness. some benefit from cognitive behavior, some from psycho dynamic. you don't have the equivalent of a drug company funding these studys so it is harder to do them for lots of reasons, that is one thing. second, i would like to try to find out ways to use less force with psychiatric patients. i was really traumatized by being in long-term restraints. anywhere from 5 to 20 hours a day for several weeks. very, very painful. caused a lot of nightmares. >> rose: tig you down.
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>> right. and then the third thing is the stigma point. understanding why and how to combat it. the final thing is not some of something we should know but do which is provide the resources so we step up to the plate and give people the abilities to lead full and pructive lives. >> rose: what a remarkae panel. what a remarkable story. >> yeah. >> rose: so looking ahead to episode ten. >> in this program we've discussed psychiatric illnesses. in the next program we're going to consider neurological illnesses. and there has been spectacular progress in treating certain kinds of neurological illness. parkinson a disease, even stroke, completely new ways of thinking about stroke. moreover we'll have a chance to discuss what is the difference between psychiatric disorders and neurological disorders. these are both brain disorders but one of the interesting things is that even though there is some overlap, one feature about
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psychiatric disorders is they often reflect extensions of normal behavior so depression is th extension of sadness that you and i feel when we're disappoint. mania is an extension of theure phoria we feel after a very good program. and even schizophrenia, the delusions and hallucinations one occasionally has in dreams, in nightmares. so a lot of psychiatric symptomology are extensions. >> this is one of the things freuz emphasized. neurological diseases, fragment behavior, can often bring out completely surprising features of behavior. for example, there is with certain kinds of strokes symptom of neglect which a patient will completely ignore an arm or a leg that they have because it's paralyzed. and they will sometimes push it out of bed saying this does not belong to me. so we will not only learn about the localization of function but we will see how abnormalal functions appear
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and normal functions as fragmented in this wonderful episode coming up. >>pisode ten next month. see you then .
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>> the brain series intt most exciting scientific journey of our time. understanding the brain, a series made possible by a grant from the simon foundation. their mission is to advance the frontiers of research in the basic sciences and mathematics. >> funding for charlie rose was provided by the following: . >> additional funding provided by these funders
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